Case study of cognitive behavioral therapy for depression (2023)

1. introduction

1.1 Depression

Depression is a deep, sad state in which life seems bleak and the challenges are overwhelming. Psychological stress is believed to play a crucial role in depression. People with depression often complain of constant tiredness and trouble sleeping. Other symptoms include irritability, anger, and loss of interest in activities that used to be pleasurable. A patient may also describe her emotions as feelings of emptiness or hopelessness. In addition, people with depression may have trouble concentrating, have memory problems, have difficulty making decisions, and may have trouble keeping normal work hours or meeting social obligations.

1.2 Cognitive-behavioral therapy

According to cognitive therapists, people with mental disorders can overcome their problems by developing new and more functional ways of thinking. Cognitive behavioral therapy helps the client make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they are affecting him or her. These parts include situations that are more of a problem, event, or difficult situation. This is followed in the first part by thoughts, emotions, physical sensations, and actions. Therefore, therapists guide clients to question their dysfunctional thoughts and try new interpretations and ultimately apply the new ways of thinking in their daily lives.

1.3 Cognitive behavioral therapy for depression

For a patient with mild or moderate depression, CBT is known to be the most promising treatment. In patients with major depression, this is an effective treatment in conjunction with drug treatment. The main objective of CBT is to find out if a person's mood is directly related to their thought patterns.

This therapy has two main approaches to treating people with the disorder, consisting of cognitive and behavioral approaches. In the cognitive approach, the client's thought pattern is positively manipulated through working with the therapist. This is also known as cognitive restructuring.

Second, the behavioral approach involves the therapist helping the patient assess how their daily activities may affect the patient's mood. Therapists often help clients develop an action plan. In this approach, the therapist and patient create a list of activities, which are ranked from least to most difficult to perform. As the patient transitions from lighter to heavier activities, her sense of control improves as her depression lessens. The technique essentially focuses on the immediate present, helping the patient see what and how a person is thinking, rather than why a person is thinking that way.

2. basic information

2.1 Reasons for transfer

Lakshani was once an active teenager who is now constantly idle at home or in bed. She shows no interest in any activity and seems to have no motivation or energy. She sleeps excessively and is always melancholy. Therefore, Lakshani's mother took her to a psychiatrist, who referred her to a psychologist, believing that psychotherapy would be more beneficial for the patient.

2.2 represent problems

Lakshani not only enjoyed playing badminton with her friends and neighbours, but also loved to read, sing and dance. In the last 3 months, her life has changed drastically. For example, before her behavior change, she liked to help her mother in the kitchen. However, now she spends all day curled up in bed. Her mother also noticed her loss of appetite. She says that she feels tired and sleepy all the time. She no longer feels motivated to get involved in any activities and she has no goals planned for the future.

2.4 History of psychiatric and previous treatment

Lakshani previously had bouts of depression after her father abandoned her when she was 8 years old and was therefore prescribed antidepressants. She did not receive psychotherapy for this. As of now she is on a low dose of antidepressants.

2.4 Relevant Surnames

Lakshani is the only daughter in her family. When Lakshani was only 8 years old, her father divorced her mother to marry another woman. Although she was close to her father before this incident, she Lakshani did not get a chance to see him after she left. This was mainly because her parents ended things on particularly bad terms. However, her father took her life a year ago and, with the support of her mother, the couple reconciled. According to Lakshani, it was difficult for her to find herself again, especially since he has a new family.

The mother did not remarry and would have been quite saddened by the separation. Although her mother's suffering was obvious to Lakshani, she did not know what to make of it, as Lakshani herself was trying to handle the situation as best she could.

During this ordeal, she became very attached to her grandparents. She is particularly close to her grandfather.

2.6 Premorbid personality

Lakshani was a sociable girl who could easily make friends. She liked school and she showed great interest in certain activities and hobbies, such as playing badminton with her neighbors, reading, singing and dancing, as mentioned.

formulation 3.0

Lakshani's cause of her depression is gradually contained through many different incidents. The first event that affected her was the divorce of her parents. That incident hit her so hard that she couldn't go to school for a month afterward. The subsequent onset of similar events, particularly the violent breakup with her boyfriend, led her to believe that no one cares about her in her life and that they will all eventually leave ("no, I'm not smart, obviously I'm useless, no one cares for me." wants."). Thus, her pattern of attributing everything about herself negatively perpetuates her depressive symptoms. This formulation identifies the various incidents that may have contributed to Lakshani's negative thought pattern.

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4. Intervention

4.1. Summary

Lakshani received weekly consultations and was required to attend 12 sessions over a period of 6 months. Her treatment consisted primarily of cognitive behavioral therapy approaches to identify and change negative dysfunctional thinking, as well as learning ways to prevent future relapses.

4.2 Commitment and psychoeducation

The initial treatment session worked to build a positive therapeutic alliance while maintaining professionalism. Lakshini revealed the recurring negative dysfunctional thoughts and how so far she has not made any courageous effort to change these considerations. Her symptoms were discussed and depression was diagnosed. A dialogue about depression was then introduced and Lakshini was educated about its influence on a person's behavior and how Lakshini experiences it personally. The structure, purpose and specific objectives of the next sessions were established, as well as the rules of therapy and the limits of confidentiality. The following three objectives were jointly identified

1) Short-term goal

Identify dysfunctional thoughts and how they affect Lakshani's mood and behavior.

2) Medium-term goal

Be more dynamic and participate in enjoyable activities.

3) Long-term goal

Develop interpersonal skills and a social support network.

Lakshani was informed that she will receive apersonal projectat the end of each session to complete them before the next session. This includes completing a 'mood thermometer' which allows for a better understanding of the intensity of depressive symptoms and the client's specific mood at the end of each day. Lakshani was also asked to keep a diary of all her positive and negative thoughts. Finally, she was asked to keep a weekly schedule of all the positive activities in which she was involved.

4.3. mood thermometer

Mood Thermometer allows Lakshani to measure your mood on a specific day of every week. The chart is examined before the start of the next session to measure Lakshani's progress. On the mood thermometer, Lakshani should score between 1 and 9, where 9 represents Lakshani's happiest feeling and 1 represents the worst.

4.4 Relaxation exercises

Lakshani is asked to do specific relaxation exercises at home, especially when she feels stressed. This could include deep breathing exercises, asking her to sit in a comfortable position at home as she breathes out and slowly inhales to ensure that she is only concentrating on her breathing. This will allow you to put aside any other intrusive thoughts in her head and she will be able to feel more calm and uninterrupted. Other breathing exercises may include relaxation responses and progressive muscle relaxation. These breathing exercises can be followed by a visualization exercise in which Lakshani is asked to imagine or visualize herself in a specific scenario that she finds most calming or relaxing.

4.3 Acknowledge negative thoughts. (session 1-4)

While Lakshani's negative thinking errors and dysfunctional thoughts were identified and defined in the first session, the next three sessions will work on how to discuss and modify these thoughts to improve your state of mind. Exercises can be done in the session to identify her common thinking errors. These sessions will teach Lakshani strategies to increase positive thoughts and decrease harmful or dysfunctional negative thoughts, thereby reducing depressive symptoms. In other words, the cognitive restructuring of her negative thoughts is followed by behavioral experiments in which she learns to act on situations that acted as triggers for her dysfunctional thoughts.

cognitive restructuring

behavioral experiments

After cognitive restructuring, in the behavioral experimentation phase, the Lakshani is asked to become familiar with their newly constructed thought patterns. To do this, he is first asked to do a role play in which he imagines a situation that is particularly difficult for him. He is gradually encouraged to engage in these new behaviors outside of the therapist's office. This would eventually reduce her unhealthy thinking and successfully reconstruct her behavior to better fit the situation (Pomerantz, 2013).

4.4 Engage in Enjoyable Activities/Activation of Behavior (Sessions 5-8)

Lakshani explains how the presence of depression can limit participation in pleasurable activities, which in turn increases depressive symptoms. During these sessions, the activities that Lakshani enjoys are determined and the obstacles that prevent her from engaging in these activities are also identified. Lakshani is given a list of enjoyable activities and is then asked to mark each activity that she does on that particular day. This keeps track of her progress and motivates them to engage in more and more positive activities. This, in turn, will reduce her depression.

To make things simpler and easier for her, you can set concrete and clear goals together and she can learn the steps to reach those specific goals.

weekly activity plan

This schedule contains all the activities that Lakshani will be involved in during the week. You are prompted to type a plus sign (+) if they are positive and a minus sign (-) if they are negative.

4.6 Development of interpersonal relationships (Session 9-12)

Lakshani learns how the way she interacts with those around her can affect her "mood" and vice versa. In this way, she learns what a good social support network needs and how to recognize and strengthen it. However, she also needs to understand that relationships are always changing and that certain relationships that don't work out don't necessarily mean she's at fault. As such, she is taught to maintain healthy relationships with her peers and family, considering that the deterioration of certain relationships is inevitable and such changes must be accepted.

There will also be specific exercises to help Lakshani build better relationships with her peers, where she will learn to set realistic expectations of them. In addition, she learns confident communication skills to help her interact with her friend without feeling pressured or insecure.

Lakshani is also asked to build her own social support network to gauge who she trusts the most in her social circle and whom she considers her close friends and family. When Lakshani's social circle is very small, she is asked to enlarge it as she needs a group of people that she can trust. A good social support network will greatly reduce her depressive symptoms.

4.7 Theme integration and therapy evaluation

The final session will integrate all the questions from the previous session while reviewing and evaluating the therapy and all the activities Lakshani was involved in. Lakshani receives information about her participation and her progress during the sessions. She is asked to give feedback on her personal opinions and experiences throughout therapy. She also learn strategies that can prevent a relapse.

HABITS TO AVOID

• thinking all nothing
• evaluate the positive
• conclude hastily
• perfectionism
• Label yourself or others
• blame yourself